Provider Demographics
NPI:1609294321
Name:MOUNTRAIL COUNTY SOCIAL SERVICES
Entity Type:Organization
Organization Name:MOUNTRAIL COUNTY SOCIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:QUIGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:701-628-2925
Mailing Address - Street 1:PO BOX 39
Mailing Address - Street 2:18 2ND AVE SE
Mailing Address - City:STANLEY
Mailing Address - State:ND
Mailing Address - Zip Code:58784-0039
Mailing Address - Country:US
Mailing Address - Phone:701-628-2925
Mailing Address - Fax:701-628-3175
Practice Address - Street 1:18 2ND AVE SE
Practice Address - Street 2:
Practice Address - City:STANLEY
Practice Address - State:ND
Practice Address - Zip Code:58784-0039
Practice Address - Country:US
Practice Address - Phone:701-628-2925
Practice Address - Fax:701-628-3175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-31
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND000050741Medicaid